Barriers and Facilitators to Undergoing Hepatitis C Virus (HCV) Testing through Drug Treatment Programs

Abstract

astone-twerell, Don C. Des JarlaIs, Marya gwaDz, holly hagan, anDrew osborne, anDrew rosenbluM Given the high prevalence of hepatitis C virus (HCV) infection among drug users, HCV testing is critical in this population. While many drug treatment programs offer HCV testing, patients often do not utilize this essential program-facilitated service. Summarizing data collected in semi-structured interviews and surveys with patients in 25 programs, this paper identifies barriers and facilitators to being tested for HCV through the program. Barriers include the patient's belief that she/he is not HCV infected, fear of needles, fear of obtaining a positive HCV test result, fear of disclosure of such a result, and fear of inappropriate or disrespectful treatment during the testing process. In addition, 38% of HCV sero-unaware or sero-negative patients completing the survey did not know that HCV testing was offered through their programs. Salient facilitators for those tested through their programs include support from staff in explaining the importance of testing and help in understanding and coping with test results.

Barriers and facilitators of hepatitis C screening among people who inject drugs: a multi-city, mixed-methods study

“…Stigma was a theme in respondents’ discussion of barriers to HCV testing, which is consistent with previous research [23]. Participants in our study did not frequently express concerns about stigma from medical professionals or needle-exchange staff, as has been reported previously [25-27].…”

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

“…A lack of knowledge of HCV symptoms and transmission were common among PWID Rhodes, Davis, & Judd, 2004;Gyarmarthy et al, 2006;Lally et al, 2008;Ellard, 2007), particularly among those who had not previously been tested . Such gaps contributed to delays in seeking testing (Strauss et al, 2008;Swan et al, 2010;Lally et al, 2008;Southgate, Weatherall, Day, & Dolan, 2005) and individual barriers to testing uptake among PWID, such as fear, were often related to incomplete knowledge about HCV.…”

“…) Experiences of being informed on the outcome of testing were generally poor. Many PWID remained unclear about the meaning of a diagnosis and experienced limited and inadequate information provision by health professionals, leading to substantial gaps in knowledge (Copeland, 2004;Cullen, Kelly, Stanley, Langton, & Bury, 2005;Faye & Irurita, 2003;Khaw et al, 2007;Lally et al, 2008;Rhodes et al, 2004;Southgate et al, 2005;Strauss et al, 2008;Sutton & Treloar, 2007;Swan et al, 2010;Temple-Smith, Gifford, & Stoové, 2004;Tompkins et al, 2005). A policy of not informing 8 PWID of the outcomes of testing ("a no news is good news approach"), as described in two drugs services , also produced anxiety.…”

Desired Social Distance From People Who Have Hepatitis C Virus: An Exploration Among Staff in Health Care, Dentistry, Drug Treatment, and Tattoo/Body Piercing

“…Negative interactions in dentistry and tattoo/body piercing studios may affect help seeking behavior. Prejudicial attitudes (i.e., desire for social distance) and actions contribute to negative outcomes for persons with HCV, reducing their willingness to get tested, receive treatment, disclose HCV status, or access social support (Lee & Craft, 2002;Scambler & Hopkins, 1990;Strauss et al, 2008;Zickmund et al, 2003). Thus, policy should be directed at stigma reduction among people working in these fields and should include contact with persons who have HCV.…”

“…Furthermore, many with HCV in the United States are members of other stigmatized groups, such as racial and ethnic minorities and/or people experiencing homelessness (Lepe, Layden-Almer, Layden, & Cotler, 2006). For people with HCV, imagined or experienced rejections from healthcare or other service providers can lead to fear of disclosure, lack of access to social support, and reluctance to seek or to continue health care or substance abuse treatment (Brener, Von Hippel, Von Hippel, Resnick, & Treloar, 2010;Lee & Craft, 2002;Strauss et al, 2008;Zickmund et al, 2003).…”